Original ArticleCPAP treatment in obstructive sleep apnoea: A randomised, controlled trial of follow-up with a focus on patient satisfaction
Introduction
Obstructive sleep apnoea syndrome (OSAS) is an increasingly recognised disorder, estimated to affect 4% of middle-aged men and 2% of middle-aged women in Western countries [1], [2], [3]. If untreated, it leads to increasing medical risks and has negative effects on quality of life [2], [4], [5], [6]. The number of patients with OSAS is expected to increase considerably in the coming years, the reason for this being both a higher awareness of OSAS in the medical community and among the general public, leading to more cases being diagnosed, and an increase in the actual number of patients. One of the major reasons for the latter is the growing epidemic of obesity in the Western world, obesity being one of the major risk factors for OSAS [2], [7]. Hence, the demand on the health care system to meet the needs of patients with OSAS is expected to rise considerably.
The most commonly used treatment for moderate and severe forms of OSAS is the application of constant positive airway pressure (CPAP) during sleep. The positive effects of CPAP treatment on medical outcome and quality of life have been demonstrated in several studies [8], [9], [10], [11], [12], [13], [14]. CPAP treatment for OSAS has also been established as cost effective [15], [16], [17], [18].
However, OSAS is a chronic disease, and as with other chronic diseases, compliance with the given therapy is fundamental in order to obtain the expected outcome. For compliance with CPAP treatment, follow-up with annual review has been shown to be important [19], [20]. Given the rising number of patients with ongoing treatment, this places increasing requirements on limited health care resources.
From a patient’s perspective many patients with OSAS and CPAP treatment aim to have a normal working and social life, and it may be assumed that they want to minimize the time spent on controlling their condition. It is therefore important to optimise the follow-up model, without compromising safety.
In other medical conditions of long duration, structured follow-up visits by specialist nurses have been shown to be effective and well-functioning methods for control [21], [22], [23], [24].
For CPAP-treated patients in a stable condition, it is unlikely that severe medical events would differ according to mode of follow-up, but it is important to consider the patients’ overall satisfaction and the utilisation of health care resources. If a simplified method for follow-up is found to be acceptable and safe, it would make it possible to continue to offer qualified follow-up to this quickly growing group of patients.
The aim of the present study was to study a simplified model for follow-up visits by a specialist nurse compared with the current standard of physician-led visits regarding patient satisfaction, quality of life, medical events, and utilisation of health care resources in CPAP-treated patients with OSAS in a stable condition.
Section snippets
Study subjects
Adult patients with obstructive sleep apnoea syndrome defined as Oxygen Desaturation Index (ODI) ⩾ 4% and/or Apnoea/Hypopnea Index (AHI) ⩾ 5) with ongoing CPAP treatment, and judged to be in a stable condition, were consecutively recruited from the regular list of patients at the Department of Respiratory Medicine, Örebro University Hospital, Sweden, and assessed for eligibility for the study. They had initially been diagnosed as having OSAS by the use of polygrafy (Breas Sc 20, Breas Medical AB,
Study flow and baseline characteristics
Patients were included from October 2000 to September 2002. Follow-up visits were made after 12 and 24 months, and all patients had completed follow-up by November 2004. Eligible patients and study flow are presented in Fig. 1.
The baseline characteristics for the study population are shown in Table 1. There were no differences between the two groups.
Previous mean use of CPAP before entering the study was five years in both groups, and both the intervention and control groups reported use of
Discussion
In this randomised, controlled, open study of patients with moderate to severe but stable OSAS undergoing CPAP treatment, patients’ global satisfaction with treatment and follow-up was found to be very high irrespective of the mode of follow-up. Over a period of 24 months, we could not demonstrate any significant differences between patients controlled by a specialist nurse and those controlled by standard care in terms of their overall assessment of treatment, including compliance,
Conclusion
For stable patients undergoing CPAP treatment for OSAS, regular follow-up visits by a specialist nurse can optimise the use of health care resources while retaining high patient satisfaction, without increasing medical risks.
Conflict of interest
None declared.
Funding
Funding for this study was provided by the research fund of the Department of Respiratory Medicine, Örebro University Hospital.
Acknowledgements
We are indebted to Anders Magnusson at the Department of Statistics and Epidemiology, Örebro University Hospital for statistical advice and help with the calculations. We also thank Anette Friman for secretarial help with the article.
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M. Alton died in September 2008.